title: Procalcitonin as a marker of bacterial infection in children undergoing cardiac surgery with cardiopulmonary bypass.
abstract: BACKGROUND
  Owing to systemic inflammatory response syndrome, the diagnosis of post-operative infection after cardiopulmonary bypass is difficult to assess in children with the usual clinical and biological tools. Procalcitonin could be informative in this context.
  
  
  METHODS
  Retrospective study in a paediatric intensive care unit. Blood samples were collected as soon as infection was clinically suspected and a second assay was performed 24 hours later. Using referenced criteria, children were retrospectively classified into two groups: infected and non-infected.
  
  
  RESULTS
  Out of the 95 children included, 14 were infected. Before the third post-operative day, procalcitonin median concentration was significantly higher in the infected group than in the non-infected group - 20.24 nanograms per millilitre with a 25th and 75th interquartile of 15.52-35.71 versus 0.72 nanograms per millilitre with a 25th and 75th interquartile of 0.28 to 5.44 (p = 0.008). The area under the receiver operating characteristic curve was 0.89 with 95% confidence intervals from 0.80 to 0.97. The best cut-off value to differentiate infected children from healthy children was 13 nanograms per millilitre with 100% sensitivity - 95% confidence intervals from 51 to 100 - and 85% specificity - 95% confidence intervals from 72 to 91. After the third post-operative day, procalcitonin was not significantly higher in infected children - 2 nanograms per millilitre with a 25th and 75th interquartile of 0.18 to 12.42 versus 0.37 nanograms per millilitre with a 25th and 75th interquartile of 0.24 to 1.32 (p = 0.26). The area under the receiver operating characteristic curve was 0.62 with 95% confidence intervals from 0.47 to 0.77. A procalcitonin value of 0.38 nanograms per millilitre provided a sensitivity of 70% with 95% confidence intervals from 39 to 89 for a specificity of 52% with 95% confidence intervals from 34 to 68. After the third post-operative day, a second assay at a 24-hour interval can improve the sensitivity of the test.
  
  
  CONCLUSIONS
  Procalcitonin seems to be a discriminating marker of bacterial infection during the post-operative days following cardiopulmonary bypass in children.
authors.affiliation: Pediatric Cardiology Unit, Nantes University Hospital, Nantes, France. peseguela@yahoo.fr
authors.forename: Pierre-Emmanuel
authors.initials: PE
authors.lastname: Séguéla
authors.forename: Nicolas
authors.initials: N
authors.lastname: Joram
authors.forename: Bénédicte
authors.initials: B
authors.lastname: Romefort
authors.forename: Céline
authors.initials: C
authors.lastname: Manteau
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Orsonneau
authors.forename: Bernard
authors.initials: B
authors.lastname: Branger
authors.forename: Véronique
authors.initials: V
authors.lastname: Gournay
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Rozé
authors.forename: Christèle
authors.initials: C
authors.lastname: Gras-Le Guen
mesh_terms: D017677:Age Distribution; D001424:Bacterial Infections / Q000097:blood* / Q000453:epidemiology / Q000382:microbiology; D015415:Biomarkers / Q000097:blood; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D002315:Cardiopulmonary Bypass / Q000009:adverse effects* / Q000379:methods; D002675:Child, Preschool; D015331:Cohort Studies; D003428:Cross Infection / Q000097:blood* / Q000453:epidemiology / Q000382:microbiology; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D011183:Postoperative Complications / Q000097:blood / Q000453:epidemiology / Q000382:microbiology; D011237:Predictive Value of Tests; D011498:Protein Precursors / Q000097:blood*; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D015996:Survival Rate; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood / Q000453:epidemiology / Q000382:microbiology; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide